Abstract

Elderly care is one of the more high profile contemporary issues that confronts care professionals, the Government and its citizens. Central to these are concern how care is best regulated and the cost effectiveness of decisions to cut care delivery across the public and private sectors. Defining what constitutes good care delivery is a continuing challenge to health care managers and staff, as the benchmark is in constant flux due to advances in modern medicine and the progression of new and dangerous ill-health conditions. Culture, personal values and expectation changes from generation to generation also blur the definition of what constitutes good care. This thesis offers a contemporary analysis of care and examines how regulatory systems have been too ad hoc and often retrospective; leading to deficiencies in the pro-activity and holistic response elderly care requires to tackle its issues. This is one of the most rapidly evolving areas of regulation in a period of intense media attention and public concern over elderly care. A considerable degree of permanence can be identified towards the action plan of the Government in engaging a variety of reactionary regulatory strategies.

In the later analysis in the thesis, it is suggested that additional specialist and dedicated regulation may still prove to be necessary to secure care quality and undertake preventative measures against the abuse of this vulnerable section of the community. Public concern and medical interest continues to reveal cases of severe neglect of the elderly in many private care homes. The Care Quality Commission, the main regulator since 2009, undertakes inspections and reports on care quality, but doubts remain as to how effective the measures in place guard the quality of care in practice. The second Francis Report on the Mid Staffordshire NHS Foundation (5th February 2013) highlighted many failings in the National Health Service and showed how the most vulnerable and elderly to be particularly at risk. Reports of poor care of the elderly continue to confirm that stricter monitoring and inspections are needed.

The aims and objectives of this thesis, are to understand how elderly care regulation has addressed systemic regulatory failures and provides a case study of lessons learnt from past omissions and mistakes. At the time of writing, the Care Quality Commission has undertaken tougher inspection regimes by currently adopting a system of special measures, and new regulations are being considered. Over its approximately six years of activity since it ‘plugged a regulatory hole’ it’s now progressively much improved inspectorate function has even just embraced ‘whistle-blowing’ as part of its ‘work in progress’ profile. There is continued pressure on the regulator to meet expectations of ensuring high quality care, and it is also a response to the changing role of care homes; reflecting the diverse range of care and the ageing population.

This thesis provides an analysis of how elderly care has evolved over many centuries and varied in its standards of delivery. Defining appropriate levels for care standards is one approach, adopting a holistic approach is another, but the culture of care is one that needs to be fostered through family members who are often engaged in the delivery of elderly care, as well as the community at large. Developing care through purely legal mechanisms, such as the setting of care standards has its limitations, but will undoubtedly also feature as part of any perceived solution. There are signs that the changing culture in care homes and those that provide care, is a recent and most welcome shift in regulatory goals and objectives. It is argued that this change reflects positively on the current care system which has been driven by some better education of care workers and greater empathy with the elderly; an empathy which is driven by the growing reality with every new generation that most of us will live well into our elderly years due to the advancement of modern medicine.

Reflected also is increased lack of trust in people, where in the past assumptions about care delivery standards by individuals were relied upon instead, and how to engage with the continuous re-design of oversight regulatory structures issues of legitimacy and increasing public trust.

The Care Quality Commission is developing its own identity and offers a form of social regulation that is set apart from the main economic regulators. There are many lessons which can be learnt when working from within the National Health Service through the use of internal networks, access to current government policy and funding arrangements. Despite strong ministerial engagement in this area, the Care Quality Commission has been able to maintain its own voice and, in recent months, has developed its expertise to address public concerns about elderly care. Despite this, the statistics show that at least one third of care homes are regarded as less than satisfactory, suggesting that much work remains to be undertaken. Co-ordinating clinical and social care of the elderly is part of patient safety. It also connects with regulating the professional standards of health and social care professionals.